Mobile Integrated Healthcare Practice (MIHP)
With the passage of the Patient Protection and Affordable Care Act (“PPACA”), the delivery of healthcare in the United States is undergoing dramatic change. The goal of the PPACA is to reduce healthcare costs, while at the same time increasing access to and providing quality healthcare for patients. Among the areas of focus are the lack of access to healthcare for many patients, billions of wasted dollars due to inefficient delivery and excessive administration costs, failure to prevent chronic illness and disease, fragmentation of acute and chronic care, and outdated and complex reimbursement processes. All of these factors contribute to hospital readmissions for patients with chronic diseases. And, penalizing hospitals and healthcare providers for readmissions of those patients within 30 days is one of the primary enforcement methods outlined in the legislation.
Enter “Mobile Integrated Healthcare Practice” (MIHP) programs. Sometimes also known as "Community Paramedicine" (CP) prgrams, MIHP is a novel healthcare delivery platform intended to serve a range of patients in the out-of-hospital setting by providing interdisciplinary population health-based, patient-centered, team-based care using mobile resources already existing in the community. The goal of MIHP programs is to provide resource-matched, time appropriate coordinated care to patients at optimal cost by healthcare providers who are operating at the top of their license. The benefits of MIHP programs include: coordination across healthcare systems and providers; validated data collection; and provision of care to unserved / underserved segments of the population – all while promoting the objectives of the IHI Triple Aim.
The basis for MIHP programs is leveraging the Emergency Medical Services (EMS) systems infrastructure already existing within the community based on local needs assessments including gap analysis, and is designed to involve partnerships with existing community stakeholders in order to meet identified needs, including nursing, home care, hospice, primary care, and mental health. EMS systems offer a preexisting capital-intensive, difficult to replicate “readiness” – costs such as 24/7 vehicle fleets, robust voice and data communications, portable biometric and monitoring devices, electronic health record systems and treatment equipment are already built into the existing system and can be used to promote the community program needs. Furthermore, EMS systems are easily scalable to absorb new or expanded mobile health strategies, and can do so with minimal marginal costs. By leveraging resources already existing in the community, and effectively coordinating care across healthcare provider disciplines based on patient needs, MIHP programs provide a strategy for correcting some of the shortcomings of the U.S. health care system – including, most importantly, reducing preventable readmissions - and most communities would be hard pressed to recreate such a system without investing exorbitant sums of money.
MIHP emphasizes the importance of providing the right care, at the right time, in the right place and at the right cost. The collaboration between a variety of public safety and health care partners promises to provide 24/7 care—whether acute or chronic, at home, in a clinic or in another out-of-hospital location.
Successful MIHP programs are developing in communities across the country. These programs have been designed to impact specific population needs and address glaring inefficiencies within local systems. Examples of successful programs include: CHF Readmission Avoidance, 911 Nurse Triage, Hospice Revocation Avoidance, Post-Discharge Readmission Avoidance, Observation Admission Avoidance, Home Health Partnerships, Resource Access Programs, and Mental Health Follow-Up Programs.
Comprehensive and accountable MIHP programs will include many of the following features:
• Program and healthcare outcome goals informed by a population health needs assessment
• Patient access through a patient-centered mobile infrastructure
• Delivery of evidence-based interventions using multidisciplinary and interprofessional teams composed of providers operating at the top of their respective scopes of practice
• Improved access to healthcare and health equity through 24-hour availability
• Patient-centered healthcare navigation and population-specific healthcare services
• Full utilization of existing infrastructure and resources, including telemedicine technology
• Integrated electronic health records and access to health information exchanges
• Provider education and training based on assessments of program needs and provider competencies
• Physician medical oversight in program design, implementation and evaluation
• Strategic partnerships engaging a spectrum of healthare providers and other key stakeholders
• Financial sustainability
• Quality outcomes performance measurement and program evaluation
One critical misconception about MIHP programs is that they are designed to replace or compete with other health care systems and allied health professionals, such as home health care or visiting nurses. That is absolutely not the case. In fact, in order for MIHP programs to be successful, they require enhanced coordination of care between existing healthcare stakeholders who partner with each other and bridge gaps. This is a point which is often missed, overlooked, or misunderstood by many healthcare providers.
In short, MIHP is a unique approach to common problems, and an idea whose time has come.
The Bloominghill Group is uniquely situated to assist health care systems, allied health professionals, and EMS systems develop and implement Population Health and MIHP programs within their communities. Our primary focus is aimed at building and creating the community partnerships necessary to form successful alliances, all while leveraging existing resources and capitalizing on existing strengths within your local community. Contact us today to learn more about our MIHP program services and how we can assist you.